MEDICARE: MS. QUANDA MICHON GRIFFIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001150167	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024168269	VA

General Provider Information

NPI Number	:	1063556363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. QUANDA MICHON GRIFFIN NP

Provider Business Mailing Address
First Line	:	620 JOHN PAUL JONES CIR BLDG 104
Second Line	:	NAVAL MEDICAL CENTER PORTSMOUTH
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:	757-953-9822
Fax Number	:	757-953-9999

Provider Business Practice Location Address
First Line	:	SOUTHEASTERN VIRGINIA HEALTH SYSTEMS-48TH STREET PHYSIC
Second Line	:	4714 MARSHALL AVE
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608
Country	:	US
Telephone Number	:	757-380-8709
Fax Number	:	757-952-1345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	01/08/2020

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